When you might as well use Dr Google

[Paks]

I was at a lesson this sunday and my trainer suspected my and my husband’s horse had lymes disease. What he saw was my horse tripping, getting tired quickly and becoming discoordinated in his gaits. My husband’s horse was having problems staying in gaite and cantering even with the trainer on and getting tired much more quickly than normal. My trainer also said my horse seemed to have transient lameness. Looking like off in one leg then another and it was constantly shifting around. He said that he has found tripiness to be an early sign of lymes. So we get the vet out.

She does a physical my horse has temp of 98.2 but she says that is normal. She pulls the titer, doesn’t have the snap test. Says we will get the results in 5 days. but doesn’t want to start treatment to avoid antibiotic resistance. I said neither horse has been on systemic antibiotics for 7 years, they are not candidates for resistance. She says tripping and transient lameness are only anecdotal signs of lymes but aren’t documented signs of lymes. I told her trainer said tripping is one of the first signs he sees of lymes. She goes that’s not what the books say and it’s just his opinion. I said it’s his opinion based on over 30 years dealing with gaited horses and lyme’s disease. Response, well that’s not what the books say. I also told her that the human protocol for lymes was to start treatment while waiting for the titer to come back. She said that was not what the veterinary world does. But she will prescribe the pills if we insist against her better judgement. So we are starting treatment.

And really if all she is going to do is take into account what the books say and not observations or experience. I might as well used Dr Google and do my research on line with NIH etc. Lots of peer reviewed stuff there. I want a vet to be able to consider the patient and the experience of others and herself when deciding on a treatment plan not just go by what is in some checklist or manual. The way she acted she could have 30 horses with whose first sign of something wrong was tripping and they it was shown to have lymes and she would still wait for a text book to say it was an official sign before she would consider lymes when a horse is tripping. Learning for vets doesn’t stop at the books and peer reviewed journals.

[Simkie]

Not once in my very many Lyme (no “s”) positives have we started antibiotics before seeing the titer. None of my vets have snap tests, they’re not very reliable. Titers are sent to Cornell. Treatment starts once we’ve seen the number and considered the history.

Nothing in your vet’s actions here is really amiss, although I’m sorry you expected something different.

[beowulf]

Same experience as Simkie and I live in a Lyme centric area. I’ve dealt with Lyme disease now in probably close to 100 horses (mostly boarder/clients) with about a dozen being my own. Not once have we ever started antibiotics before the test comes back. Additionally I think there is some misunderstanding about antibiotic resistance — it’s not your horse she’s concerned about, it’s the disease — which has shown some recent resistance to standard ABX like doxycycline.

I should also add that tripping has not been high up there in my list of clinical symptoms of the disease either. Usually it’s a loss of performance and overall body soreness or malaise — sometimes even loss of personality or dullness. In one of my own horses he did occasionally have a slipping stifle that was attributed to the Lyme, but no tripping.

I’m sorry this wasn’t the experience you expected but from what you’ve communicated here, I think you owe your vet an apology if you want to continue to be her client. She must be a very kind human to have allowed someone with no veterinarian experience to tell her how to do her job.

[FjordBCRF]

I live in an area where Lyme is starting to become more prevalent. With that said, I know many people who have run titers on their horses only to come back negative and the issue being something else. It’s pretty standard NOT to treat until you know if you even need to and have identified what you are treating for.

[Paks]

Yes I did expect the human protocol and I expected her to use reasoning and not just keep saying what the book says. The best diagnosticians I know both human and veterinary don’t just keep to what the books says but incorporate other observations their own and others along with experience in their diagnosis. They wouldn’t offhand dismiss the observations of someone with 30 years experience in gaited horses and personal experience in the patients. She didn’t even want to know what specifically he had observed during the lesson. Didn’t want to know the frequency of the tripping when or how it occurred. On what ground etc. Because by her book incoordiation and lameness that seemed to go from y one leg to the next we’re not official symptoms of lyme and was not important. (BTW Cornell does list those as symptoms of Lyme) She didn’t want to hear how the frequency and severity of the tripping was increasing (my reason for wanting to start treatment this week not wait for another week as if it is Lyme I want it’s progression to stop now.) I consider the extremely slight risk of antibiotic resistance developing in two horses with no history of antibiotic treatment in the past 7 years to be worth the potential benefits of stopping further disease progression if it is Lyme. But really the point is if all the vet is going to rely on is what is in the book they read is it any wonder owners go to Dr Google? I can read to. I’m looking for reasoning not checklist diagonals and treatment plans.

[S1969]

A fever of unknown origin will often get antibiotics in my area - but rather than Lyme it’s more likely anaplasmosis.

But without a fever? It could be anything. I agree that it’s not likely to be treated without a positive titer.

And for both horses to have similar symptoms - I wouldn’t think tripping/lameness = Lyme. I would think feet, trim/shoes/laminitis first. Are they on spring grass?

[CBoylen]

Your horse is equally likely to have EPM. Wait for the panel to come back.

[Paks]

A bit of history here. I once didn’t stop a doctor from doing that I felt was wrong for my daughter. He was following the checklist not considering the patient. She died 5 minutes after he was done. So forgive me if when I hear someone quote the book and not apply reason alarm bells go off. And while not a vet I do have a strong medical background. Both from training and experience. And one thing I know is an informed patient is a live patient. I do not worship at the alter of a medical degree and accept all without question.

[Angela_Freda]

You need a new vet, since you clearly don’t respect this one.

[Angela_Freda]

@Paks

I consider the extremely slight risk of antibiotic resistance developing in two horses with no history of antibiotic treatment in the past 7 years to be worth the potential benefits of stopping further disease progression if it is Lyme.

You’re still misunderstanding AB resistance.

@Paks

I do have a strong medical background.

[JB]

@Paks

She says tripping and transient lameness are only anecdotal signs of lymes but aren’t documented signs of lymes.

The problem is, they are also signs of EPM, or PSSM, or any number of other things, including kissing spine or wobblers or even just some injuries like to the SI. Given how relatively little time it takes to get test results, given that this isn’t a life-threatening thing like PHF or anaplasmosis, your vet was right to not want to Rx an antibiotic based just on your horse’s symptoms. 5 days isn’t going to make a difference.

The 2020 AAEP info on this says

At this time, documented syndromes attributed to B. burgdorferi include
neuroborreliosis (ataxia, atrophy, cranial nerve deficits, stiff neck, cutaneous
hyperesthesia), cutaneous pseudolymphoma (dermal masses at the site of tick
bite), and uveitis (blepharospasm, epiphora, yellow-green fibrinous aqueous
flare). Limited proof exists for non-specific syndromes including lameness, poor
performance, arthritis, and body soreness, but these signs might be possible as
the organism preferentially resides in synovial membranes and close to blood
vessels and nerves in connective tissue

I am quite sure that the more Lyme horses are formally documented, the bigger this list will grow. I know of a LOT Of horses whose symptoms have only been travelling mild lameness, who were eventually Dx’d with Lyme. I can only hope more and more of those get documented so more vets will start to recognize this as at least a possibility.

Human treatment of Lyme is ahead of the game compared to treating horses, and even human treatment is “behind the times” in that there are still so many Drs who don’t think Lyme exists in their area or worse. Heck, there are vets who still think horses can’t get Lyme at all

I’m grateful to have a GP who is very ok with giving me Doxy if I have a weird tick bite, thankfully I’ve only done that twice. She is very much on board with not waiting to see her patients actually get Lyme. I’m sure things are different if she’s got someone coming in with every tick bite they ever get, but that’s not me.

Lyme is just so full of symptoms that aren’t textbook. My mare was just a little bit lower energy. Not lame, not tripping, still full normal appetite, normal temp, she didn’t look “wrong” to anyone else but me. I discussed with my vet testing for PPID (she’s 22) and Lyme, and I decided to g with Lyme first, and she agreed that was reasonable EVEN THOUGH she has not had much experience with Lyme at all, and she’s been practicing in this area for over 30 years. Her titer came back at 13,000. And I learned a few weeks ago that a next door neighbor has chronic Lyme from a tick bite that at first she ignored, then for a long time her Drs ignored

@Paks

I consider the extremely slight risk of antibiotic resistance developing in two horses with no history of antibiotic treatment in the past 7 years

It has nothing to do with the horses, and everything to do with what past exposure the organisms have had to this class of drugs

Vets have a responsibility to first go “by the book”, or it’s just a Wild Wild West out there.

@Paks

I once didn’t stop a doctor from doing that I felt was wrong for my daughter. He was following the checklist not considering the patient. She died 5 minutes after he was done. So forgive me if when I hear someone quote the book and not apply reason alarm bells go off.

I am SO very sorry about your dtr, I simply cannot begin to imagine Remember though that 5 days waiting for a Lyme test is not going to make or break things. And given your horrific experience, you’re going to probably always be predisposed to jumping to the conclusion that “hoofbeats mean zebras”.

Nobody should just blindly accept medical competence. But the opposite can’t be to always demand your own set of treatment protocols, especially when you don’t have a diagnosis, especially when it’s not remotely life-threatening at the moment, and with only a set of symptoms that could belong to any number of things.

[NaturallyHappy]

I’m so sorry.

[ottbee]

@Paks

I also told her that the human protocol for lymes was to start treatment while waiting for the titer to come back.

CDC says typical human symptoms for lyme disease are “fever, headache, fatigue, and a characteristic skin rash called erythema migrans” (the bullseye rash). Fever, headache and fatigue are vague symptoms that can be attributed to many different causes (much like tripping in a horse). It is absolutely NOT the “human protocol” to prescribe antibiotics for lyme disease any time a patient walks in with those vague symptoms only.

If there’s more than the vague symptoms, i.e. in the presence of the bullseye rash or even when a significantly engorged deer tick is removed, I have seen doctors prescribe antibiotics before titers come back, absolutely. But that’s with more to go on than the vague symptoms that have a lot of causes, many that are more likely than lyme.

[Simkie]

@Paks

Yes I did expect the human protocol

What “human protocol”? Are you referring to tick bite prophylaxis? That’s a double dose of doxycycline, one time, after finding an engorged deer tick attached.

In people, treatment generally follows titers. But we can also talk to people about how they feel, about when it started, and about what they might have seen on their bodies recently–like ticks, or a rash.

You clearly don’t trust this vet. Which is fine, you certainly don’t have to. But in that case, stop using her, and find a vet you do trust.

What’s your plan if the titer is negative?

[FjordBCRF]

Here’s the thing. Human doctors, horse vets, small animal vets…they have to work with what we can give them, at least humans can talk and give specifics. Even with that, as someone who did the research on my on condition, presented it to my doctor, we explored it a little more together and lo and behold, I was right. Does that mean I don’t trust my doctor? Absolutely not. I respect that my symptoms were consistent with many other things and could be something or nothing. What tipped me off was a wellness check at work where they noticed a high but not super high, resting heart rate and asked if I had just had caffeine or was stressed about the day, and neither was the case. That is also something that can be chalked up to stress being at the doctors office when they take it there and it wasnt so high that it was like “WHOA”. That bit of information helped me tremendously and changed my life after starting beta blockers.

I don’t know if OP is going to find a vet they trust given their history. If you can’t find one your trust, at least find one you feel like you can communicate with. I can have conversations with my vet about things I see online and he doesn’t look at me like I’m fruit loops or dismisses the conversation. If you go into any conversation with a vet or a doctor dismissing their education and profession you aren’t doing yourself any favors. The fact that you referred to it as “lymes” something like 8 times in your post and your very clear lack of understanding about antibiotic resistance, made me (and makes me) think you really didn’t know that much despite your “medical background”.

[Simkie]

@FjordBCRF

The fact that you referred to it as “lymes” something like 8 times in your post and your very clear lack of understanding about antibiotic resistance, made me (and makes me) think you really didn’t know that much despite your “medical background”.

I think it’s pretty likely, too, that the vet DID try to explain her thought process and the equine research and the equine treatment protocol, and was just shot down.

I totally get it’s hard to hear something other than what you expected from vets or doctors–especially when there’s been an experience of medical trauma. But, and I say this as someone who was pretty badly harmed by a surgeon, at some point, you’ve got to find people you can trust, and believe that their experience and education beyond yours is informing their choices in a way that’s best for your horse. Ask all the questions, but there’s got to be some faith in them.

[demidq]

I think that what your vet meant by “that’s not what the books say” is “that is not evidence based medicine”. Medical practitioners make decisions based on the history of the illness/condition, physical examination and investigations. Treatment is planned with the benefit of research and other practitioners’ experience, not just their own opinion or experience.
It seems to me that the vet DID listen to you, your concerns and the information from your trainer. She did not dismiss your worries, but wanted to make sure that your horses were treated properly.
I repeat others’ explanation that drug resistance is a real problem, and to use antibiotics (or wormers) improperly means that over time they may no longer be effective.

[Posting_Trot]

With my previous horse I dealt with several bouts of Lyme disease. I think a large part of the problem for her was that the first time she had it, it was early enough in what has become a real epidemic that even good vets were not (yet) convinced that Lyme was an actual cause of an actual disease (this was in 2002-03).

So, we went through the diagnostic wringer: extensive lameness exams and a bone scan. (Her major symptom was mild but persistent lameness that also shifted around among her four feet.) It took a long time (multiple months) to finally arrive at a Lyme diagnosis.

I feel your frustration. But 5 days isn’t that long to wait for the results, and, as others have pointed out, if it’s not Lyme, you may have complicated the task of finding the right diagnosis by treating for Lyme. Did the vet have any other ideas about what might be going on with the horse?

I will also add that I am so sorry about your daughter. That’s truly more than any parent should have to bear.

[SillyHorse]

@CBoylen

Your horse is equally likely to have EPM. Wait for the panel to come back.

I agree. EPM is a strong possibility here.

[SharonA1]

@Paks

A bit of history here. I once didn’t stop a doctor from doing that I felt was wrong for my daughter. He was following the checklist not considering the patient. She died 5 minutes after he was done. So forgive me if when I hear someone quote the book and not apply reason alarm bells go off. And while not a vet I do have a strong medical background. Both from training and experience. And one thing I know is an informed patient is a live patient. I do not worship at the alter of a medical degree and accept all without question.

I am so sorry for the loss of your daughter. Words can’t make up for that grief.

As you say, you have a medical background so you already know that medical practice is based on data collected from evidence-based practice. I would argue that more people have died from “reasoning,” which is subjective, than from controlled, peer-reviewed, large-scale evidence-based practices.

It sounds to me, being a professional observer of the human dynamic in the medical setting, that the vet is telling you what the evidence-based protocol is, that you are resisting what the vet says because you want to go with what your trainer says, and the vet is responding by re-affirming that her role is to make decisions based on evidence-based medicine plus her own reasoning. (I am pretty sure what the vet’s definition of reason is, but I’m not sure what your definition of reasoning is unless it’s what your trainer says.)

If you don’t like the way this vet uses evidence-based medicine together with her own form of reasoning, then, as others have said, best to find another vet who will do what your trainer says, regardless of what the veterinary training and oath and collective body of experience say.

I’m not picking on you; just saying that you and this vet don’t seem to be a good fit.